Skeletal changes in endocrine disorders

Transcription

1 Skeletal changes in endocrine disorders Poster No.: P-0100 Congress: ESSR 2015 Type: Authors: Educational Poster A. C. O'Brien 1, H. L. khosa 2, A. levai 2, N. Ramesh 2 ; 1 Dublin/IE, 2 Portlaoise/IE Keywords: DOI: Bones, Musculoskeletal system, Conventional radiography, CT, MR, Complications, Education, Calcifications / Calculi, Endocrine disorders /essr2015/P-0100 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 18

2 Learning objectives The purpose of this educational poster is to highlight the different skeletal changes seen in endocrine disorders Page 2 of 18

3 Background Skeletal changes are noted in a large number of endocrine disorders and sometimes, these changes are seen initially leading to the diagnosis of underlying endocrine pathology. Some of the changes noted include, osteoporosis seen in a large number of endocrine dysfunction including Cushing Syndrome, hyperparathyroidism, hyperthyroidism, diabetes, Addison's disease; skeletal lytic lesions are noted in hyperparathyroidism, in addition to changes like subperiosteal erosions, diffuse cortical changes, soft tissues calcifications; severe changes noted in thyroid acropachy; multiple skeletal changes in acromegaly are some of the changes noted. Page 3 of 18

4 Imaging findings OR Procedure Details DIABETES Diabetes is associated with complications involving multiple organs. Patients with diabetes may present with a variety musculoskeletal complications particularly of the foot { 25 %} Abnormalities include: Soft tissue-oedema, cellulitis, ulcer, necrotising fasciitis, pyomyositis, abscess, sinus, gas gangrene Skeletal: Neuroarthropathy, osteomyelitis, septic arthritis, auto amputations. Plain films are usually adequate for diagnosis, which reveal fractures, Charcot arthropathy, osteomyelitis, gas gangrene, vascular calcifications. CT/MRI are useful for assessment of the vascular insufficiency, fractures and MRI the best for confirmation of osteomyelitis, soft tissue abnormalities, tenosynovitis ACROMEGALY: Acromegaly secondary to excess secretion of growth hormone Skeletal changes: Thickened skull vault, large paranasal sinuses, increased angle of the mandible{ prognathism}, kyphosis of the spine with increased dimensions, tufting of the distal phalanges, increased width of the bones, early osteoarthritis, osteopaenia; soft abnormality includes increase in the heel pad thickness : mm CUSHING SYNDROME: Cushing syndrome: increase cortisol-endogenous or exogenous. : Osteoporosis, pathological fractures with excessive callus formation, avascular necrosis {particularly femoral head}, increased risk of osteomyelitis. HYPERPARATHYROIDISM: Primary /Secondary hyperparathyroidism : disease is characterised by hyperparathyroid hypercalcaemia-sub periosteal resorption affecting the radial side of the middle Page 4 of 18

5 phalanges of the middle finger, medial proximal tibia, lateral end of the clavicles, ischial tuberosity, pepper pot skull, brown tumours{ frequent in the mandible, pelvis, femora}, pathological fractures. Rugger Jersey spine, Soft tissue calcifications, periarticular calcifications, THYROID DISORDERS: Thyroid Disorders: Cretinism, hyperthyroidism{ usually only osteopaenia} and thyroid acropachy. Thyroid acropachy occur in about 1% of patients with Grave's disease, changes include clubbing, swelling of the fingers and toes, periosteal new bone formation around the metacarpals, proximal an middle phalanges of the fingers, similar changes in the feet, usually symmetric CRETINISM: CONGENITAL HYPOTHYROIDISM: Delayed or fragmented appearance of the ossification centres; delayed epiphyseal closure, dense metaphyseal bands, coxa vara deformity, multiple wormian bones in the skull, poorly developed sinuses, delayed closure of the sutures. Page 5 of 18

6 Images for this section: Fig. 1: ACROMEGALY Page 6 of 18

7 Fig. 2: DIABETIC FOOT Page 7 of 18

8 Fig. 3: DIABETIC : OSTEOMYELITIS Page 8 of 18

9 Fig. 4: VASCULAR CALCIFICATION Page 9 of 18

10 Fig. 5: HYPERPARATHYOIDISM Page 10 of 18

11 Fig. 6 Page 11 of 18

12 Fig. 7: ACRO-OSTEOLYSIS Page 12 of 18

13 Fig. 8 Page 13 of 18

14 Fig. 9 Page 14 of 18

15 Fig. 10 Page 15 of 18

16 Conclusion Skeletal changes are common in endocrine dysfunction and can often be the initial presentation. Awareness of these changes will reduce morbidity and mortality,particularly in a diabetic patient Page 16 of 18

17 References 1. Radiol Clin North Am Jan;29(1): Radiologic manifestations in the musculoskeletal system of miscellaneous endocrine disorders Chew FS 2. Case 1834 N.Ramesh, M O Dowd, A. Fernandes, G D Hurley (2002, Nov 19). Acro-osteolysis in hyperparathyroidism, {Online} URL: DOI: /EURORAD/CASE Curr Opin Rheumatol Jan;17(1):64-9. Musculoskeletal manifestations of endocrine disorders Jacobs-Kosmin, D DeHoratius RJ. 4. Endokrynol Pol Sep-Oct;60(5): Actions of thyroid hormones in bone Williams GR Page 17 of 18

18 Personal Information AMY O'BRIEN HUMA KHOSA ANDREA LEVAI NAGABATHULA RAMESH RADIOLOGY DEPARTMENT MIDLAND REGIONAL HOSPITAL PORTLAOISE IRELAND Page 18 of 18